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Type and Title of Submission


Title:

The use of a liaison psychiatric nurse to promote good health, treatment and prevention of mental ill health in a general hospital setting.

Description:

We describe how the liaison psychiatry service at a district general hospital has progressed and developed its remit from a focus on the A&E department to providing a service for all patients with mental health needs related to physical health problems. NICE guidance in both mental and physical health has been a catalyst to the development of this service where recommendations focus on all aspects of patients health and well being. The intervention includes education on mental health needs, changing attitudes and belief, a description of the process and some results of monitoring and audit which show an effective intervention for health care workers, patients and carers alike.

Category:

Clinical

Does the submission relate to the general implementation of all NICE guidance?

No

Does the submission relate to the implementation of a specific piece of NICE guidance?

Yes

Full title of NICE guidance:

cg48 - MI: secondary prevention

Category(s) that most closely reflects the nature of the submission:

Service development

Is the submission industry-sponsored in any way?

No


Description of submission


Aim

To provide a service and improve health outcomes for adults who have a physical illness which impacts on their mental and psychological well being. The service will be informed by the NICE guidelines for physical treatments such as respiratory and cardiovascular and use recommendations from guidelines for the treatment and use of anxiety and depression.

Objectives

1) To provide a clinic in the general hospital for patients who have chronic physical ill health and mental health and psychological problems associated with this, such as anxiety and depression. 2) To provide the care in a manner which removes the stigma attached to mental health and mental illness and which makes use of up to date research and education to increase awareness for all health and social care professionals when providing care to individuals experiencing mental illness or mental health related issues. 3) To improve the health outcomes of people with chronic and major physical health problems by addressing debilitating mental health issues. To be measured by reducing re-admission rates to acute wards.

Context

A liaison psychiatry service has been in place in the general hospital for 10 years. Experience and practice in the service suggests many people can develop mental health problems during major changes in physical health which escalate without intervention. Research also suggests that timely preventative measures and health education can reduce demand on services and greatly improve the quality of life for the patient. Timely psychological interventions can have a similar effect. We identified that many people experience mental health issues but have limited or no access to services when these problems are related to physical health treated in general hospital settings. The consultant physicians are not qualified to provide brief interventions and self help, primary care have limited capacity, and the patients are not ill enough to qualify for secondary mental health services. The liaison nurse targeted personal development and, in particular, post grad qualifications, towards providing the type of liaison psychiatry service which isn't just involved in the A&E department but provides ongoing, holistic care for a much wider set of needs related to mental health. This includes a teaching qualification which was essential to raise the profile of mental health needs and address negative attitudes and beliefs about mental illness currently held amongst some healthcare workers. Many patients also hold negative beliefs and attitudes about mental health and promoting positive attitudes was therefore fundamental to the programme offered. Firstly, we focussed on patients with cardiac problems and developed strong links with the cardiology department, accepting direct referrals from Cardiology. This has developed further over the past two and a half years to include referrals for all patients experiencing any mental health issue, as a direct result of their physical condition. Similarly their mental health could have caused a physical problem such as self-harm.

Methods

1) The liaison psychiatry team now offers a wide range of mental health and psychological interventions for patients through the use of out-patient nurse led clinics. The clinics focus on adjustment issues which often incorporate anxiety and depression. The general physicians complete a HAD scale and refer direct to the service. This is accepted if appropriate, if not, the team offers the most appropriate route of action by signposting or advice on management. The patient is then assessed in the out patient nurse led clinic and offered follow up sessions. 2) The team uses health promotion and up to date research to explain and explore mental health issues to patients, carers and all health care professionals to develop a more positive view of mental health generally. By providing advice and education both formally and informally the team have been instrumental in changing attitudes and beliefs about working with individuals with mental health issues. This is evident in the increase in contacts from colleagues asking for advice and in the number of relevant referrals we now receive to the clinics. 3) People who attend the clinics have fewer re-admissions and contacts relating to physical problems and their condition.

Results and evaluation

The team incorporate all NICE guidelines relating to mental illness. They also use the care programme approach, utilising care planning and reviews to regularly monitor individual progress. Patients, carers and referrers provide regular feedback on the service and care provided. This is used to inform and shape further interventions in an ongoing way. Did not attend rates are recorded. There is excellent attendance at clinics. Educational audits are completed regularly to highlight best practice. Regular meetings with multidisciplinary colleagues in the hospital. A psychiatric liaison service conference has been held this year held this year with a range of speakers from mental health and physicians highlighting joint working addressing physical and mental health care needs.

Key learning points

All illness impacts on other aspects of self, therefore we have to consider the whole concept of the person in order to fully treat them. Each health care team should be mindful of the need to explore the way in which illness affects someone's life. In particular the way the individual thinks and feels about it. Health care professionals should be aware of the need to be preventative and informative. They need to know how to identify an area of mental health, follow up, referral and where to seek advice. All general hospitals should have a psychiatric liaison team who are not just involved in the A&E environment but in the overall holistic care of the patients. Excellent care facilities must be available to the liaison team. There has to be a link to all care providers to ensure consistency of aim with the patient central to that. In terms of economy and effectiveness we prevent re-admissions for physical problems and escalation of mental illness by adopting the preventative model that supports the underlying principles of NICE guidance.

Contact Details

Name:Wendy Harlow
Job Title:NICE & SCIE Implementation Facilitator
Organisation:Sussex Partnership NHS Foundation Trust
Address:Aldrington House, 35, New Church Road
Town:Hove
County:East Sussex
Postcode:BN3 4AG
Phone:01273716585
Email:wendy.harlow@sussexpartnership.nhs.uk

 

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This page was last updated: 29 September 2008

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.